摘要
本研究要探討國內醫療廢棄物焚化爐作業勞工之易感性代謝多型性基因CYPlA1 、GSTM1 與DNA-protein crosslinks（DPC）間的相關性。 研究對象來自全省各大醫院醫療廢棄物焚化爐作業勞工，共31名，另外依照焚化爐作業勞工之性別 、年齡 、抽煙習慣等變項選取配對31名對照組，並使用問卷調查其內容包含有性別、年齡、抽煙、喝酒 、工作年資及每日處理垃圾量等。
由結果顯示，焚化爐作業勞工與對照組的基本特性，不論在年齡、性別、抽煙、吃檳榔及喝酒，二組間的比較沒有統計上的差異。易感性代謝多型性基因之分佈頻率，在焚化爐作業勞工具有CYP1A1同型合子野生型與異型合子野生型之頻率為48.4%，同型合子變異型為51.6%，而對照組則各為41.9%及58.1%，二組間沒有統計上的差異。GSTM1之比率在勞工組非無效型之頻率為58.1%，無效型者為41.9%，而對照組則各為74.2%及25.8%。
以DPC而論，焚化爐勞工明顯高於對照組，其值分別為1.5%及0.9%，以t-test檢定分析達到統計上顯著差異(p<0.01)。CYP1A1與GSTM1基因型與DPC值間的比較分析，發現無論是勞工組或對照組，其基因型與DPC值間均無統計上的差異。在DPC的多變項迴歸分析，只有有無暴露之變項，顯示有統計上的差異，其他變項均無差異。
關鍵字: 醫療廢棄物焚化爐， CYP1A1，GSTM1 ，DPC

Abstract
The issue of environmental pollution in incinerating the medical waste has been concerned by the general public. In this study, DPC in peripheral blood lymphocytes were measured as an endpoint of cytogenetic damage. However, this kind of study is frequently complicated by variants confounding factors, both endogens (sex, age) and exogenous(life style, smoking , alcohol abuse ,diet habits etc.)In this study ,31 medical waste incinerator workers and 31 normal subjects as a matched control were enrolled. The purpose of the present study is to investigate whether genetic polymorphisms in CYP1A1 and GSTM1 could explain some of the variation in DPC.
DPC levels were significantly higher in the medical waste incinerator workers compare to the control group (1.5 versus 0.9 DPC% , p<0.01).We measured the association between GSTM1 null genotype, which results in loss of enzyme activity, and DPC levels, hypothesizing that subjects with this genotype would have higher levels of DPC. However, there was no association with the GSTM1 polymorphism and DPC levels both in workers (for GSTM1 non null , DPC%=1.5; for GSTM1 null, DPC%=1.5; p=0.4)and controls (for GSTM1 non null , DPC%=0.9; for GSTM1 null, DPC%=1.1; p=0.27).Similarly, there was no association with the CYP1A1 MspⅠpolymorphism and DPC levels in workers(for CYP1A1 MspⅠwt/wt+wt/vt , DPC%=1.6; for CYP1A1 MspⅠvt/vt , DPC%=1.5; p=0.3) and controls (for CYP1A1 MspⅠwt/wt+wt/vt , DPC%=0.9; for CYP1A1 MspⅠvt/vt , DPC%=1.0; p=0.17).
Higher DPC levels in medical waste incinerator workers suggest that this group are at increased risk for exposing to ambient air pollution contaminated with PAHs .
Key word: medical waste incinerator, DPC (DNA protein crosslinks), CYP1A1, GSTM1.

目錄
中文摘要…………………………………………………………Ⅰ
英文摘要…………………………………………………………Ⅲ
目錄………………………………………………………………Ⅴ
表目錄………………………………………….……………….Ⅶ
圖目錄…………………………………………….…………….Ⅷ
第一章 前言…………………………….………………….1
第二章 文獻回顧……………………………….………….4
第一節醫療廢棄物………………….………….………4
一 國內醫療性廢棄物組成分析 ………………….4
二 醫療廢棄物焚化爐廢氣中污染物之排放………4
三 醫療廢棄物焚化爐廢氣中PAHs的排放…………5
第二節多環芳香碳氫化合物……………………………6
一 PAHs 的特性…………………………………………….6
二 PAHs的毒性………………………………………………7
第三節 CYP1A1 MspⅠ基因多型性…………………………9
一 CYP1A1 MspⅠ基因型與表現型…………………………9
二 CYP1A1 MspⅠ基因多型性與肺癌的相關研究……….10
第四節 GSTM1基因多型性…………………………….12
一 GSTM1 基因型與表現型……………………………….12
二 GSTM1基因多型性與肺癌的相關研究………………..13
第五節 DNA-protein crosslinks(DPC)…………….14
第三章 材料與方法……………………………………….15
第一節研究對象……………………………………….15
第二節研究方法……………………………………….15
一 血液樣本之收集及儲存………………………….15
二 DNA萃取…………………………………………….16
三 DNA-protein crosslinks…………………………16
四 基因型鑑定….…………………………………….18
第三節 試驗藥劑 …………………………………………22
一 DNA萃取 .………………………………………………22
二 DPC……...…………………………………………….22
三 PCR……..…………………………………….……….23
第四節 試驗材料.………….……………………………23
第五節 試驗儀器.……………………………………….24
第六節 統計方法.……………………………………….25
第四章 結果………….…………………..…………….27
第五章 討論………….……………………………….…29
參考文獻……………….……………….……….…..…31
附錄一、感染性醫療廢棄物的定義.……………………50
附錄二之ㄧ
二十一種PAHs之化合物、分子量、化學式、結構式…52
附錄二之二
二十一種PAHs之化合物、分子量、化學式、結構式…53
附錄二 DPC實驗步驟與原理…………………………….54
表目錄
表一 研究對象的基本特性…………………………….44
表二CYP1A1與GSTM1基因型的分佈與比較……….……45
表三 DPC與焚化爐作業勞工的分析……………..……46
表四 比較CYP1A1及GSTM1基因型與DPC的相關性…….47
表五 DPC之多變項迴歸分析…………………………..48
圖目錄
圖一 焚化爐作業勞工與對照組的DPC分佈圖…………49

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